Outcome-based anatomic criteria for defining the hostile aortic neck

Jordan, William D.; Ouriel, Kenneth; Mehta, Manish; Varnagy, David; Arko, Frank R.; Joye, James D.; Vries, Jean‐Paul P.M. de; Vries, Jean Paul de; Eckstein, H.‐H.; Herwaarden, Joost van; Bove, P; Bohannon, W. Todd; Fioole, Bram; Setacci, Carlo; Resch, Timothy; Riambau, Vicente; Scheinert, Dierk; Schmidt, Andrej; Clair, Daniel G.; Moursi, Mohammed M.; Farber, Mark A.; Tessarek, Joerg; Torsello, Giovanni; Fillinger, Mark F.; Glickman, Marc H.; Henretta, John P.; Hodgson, Kim J.; Jim, Jeffrey; Katzen, Barry T.; Lipsitz, Evan C.; Cox, Mitchell; Naslund, Thomas C.; Ramaiah, Venkatesh G.; Schermerhorn, Marc L.; Schneider, Peter A.; Starnes, Benjamin W.; Donayre, Carlos E.; Zipfel, Burkhart; Malhotra, Nitin; Moore, William M.; Cheshire, Nick; Bicknell, Colin; Back, Martin R.; Muhs, Bart E.; Malas, Mahmoud B.; Hussain, Syed Jawad; Gupta, Navyash; Böckler, Dittmar; Verhoeven, Eric; Reijnen, Michel M.P.J.

doi:10.1016/j.jvs.2014.12.063

Cited by 93 publications

(61 citation statements)

References 25 publications

(31 reference statements)

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“…The associations between proximal neck complications and mural neck thrombus and neck calcification are less clear in the literature, which may be caused by the diversity in onset of the complications throughout these studies. 1,2,7,9,14 When comparing our previous study 10 with this one, the results suggest that neck calcification is associated with early complications, while mural neck thrombus is rather associated with late (>1 year) sequelae. Acute complications may be associated with factors that increase the procedure difficulty (tortuous aorta) or immediately impede sufficient fixation and sealing (neck calcification); later failure may be associated with factors that do not provide a stable environment and are prone to change over time (high curvature, mural neck thrombus, and large aneurysm diameter).…”

Section: Discussionmentioning

confidence: 55%

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

et al. 2017

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Purpose: To evaluate the association between aortic curvature and other preoperative anatomical characteristics and late (>1 year) type Ia endoleak and endograft migration in endovascular aneurysm repair (EVAR) patients. Methods: Eight high-volume EVAR centers contributed 116 EVAR patients (mean age 81±7 years; 103 men) to the study: 36 patients (mean age 82±7 years; 31 men) with endograft migration and/or type Ia endoleak diagnosed >1 year after the initial EVAR and 80 controls without early or late complications. Aortic curvature was calculated from the preoperative computed tomography scan as the maximum and average curvature over 5 predefined aortic segments: the entire infrarenal aortic neck, aneurysm sac, and the suprarenal, juxtarenal, and infrarenal aorta. Other morphological characteristics included neck length, neck diameter, mural neck calcification and thrombus, suprarenal and infrarenal angulation, and largest aneurysm sac diameter. Independent risk factors were identified using backward stepwise logistic regression. Relevant cutoff values for each of the variables in the final regression model were determined with the receiver operator characteristic curve. Results: Logistic regression identified maximum curvature over the length of the aneurysm sac (>47 m −1 ; p=0.023), largest aneurysm sac diameter (>56 mm; p=0.028), and mural neck thrombus (>11° circumference; p<0.001) as independent predictors of late migration and type Ia endoleak. Conclusion: Aortic curvature is a predictor for late type Ia endoleak and endograft migration after EVAR. These findings suggest that aortic curvature is a better parameter than angulation to predict post-EVAR failure and should be included as a hostile neck parameter.

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Section: Discussionmentioning

confidence: 55%

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

et al. 2017

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“…In spite of the advantages of EVAR as a less invasive technique, in patients with hostile neck anatomy the long-term outcome is still inferior to open surgery [6, 8, 9]. …”

Section: Discussionmentioning

confidence: 99%

“…In general, several anatomical factors are taken into account when defining a hostile neck patient: neck length (usually < 15 mm), diameter (> 28 mm) and angulation (> 60°). Other adverse morphological parameters include proximal neck circumferential thrombus or calcification (> 50%) or a tapered/conical neck, wherein the diameter progressively increases between the renal arteries and the sac with a > 2- to 3-mm change over the first 15 mm of the proximal neck [2–6]. …”

Section: Methodsmentioning

confidence: 99%

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Predeployed aortic extension cuff (kilt) in EVAR with hostile neck anatomy using Endurant II system: preliminary results

Szaniewski¹,

Biernacka²,

Walas

et al. 2016

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IntroductionVarious modifications of standard endovascular aortic aneurysm repair (EVAR) have been developed to solve the problem of difficult neck anatomy.AimThe authors propose the implantation of a predeployed extension cuff (kilt) using on-shelf Endurant II elements. In a vast majority of cases, the proposed method provides a solution for the hostile neck problem using standard Endurant II elements available in all centers performing subrenal EVAR procedures.Material and methodsThe early outcomes of kilt implantation were evaluated in 11 patients (three with ruptured abdominal aortic aneurysms, one symptomatic) in 2 vascular centers in Silesia (Poland). All patients presented with hostile neck anatomy defined as neck length < 10 mm, diameter > 28 mm, angulation > 60°, mural thrombus or calcium > 2 mm in thickness or > 180° circumference.ResultsNo intraoperative type I endoleak or device migration was observed. Two perioperative deaths occurred in patients in a severe condition with ruptured aneurysms. One case of type III endoleak was managed by the implantation of an additional iliac extension with complete endoleak sealing.ConclusionsThe proposed method seems to be effective in early endoleak prevention in patients with hostile neck anatomy undergoing EVAR procedures; however, studies with long-term follow-up are needed.

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“…5,7,8 Recently, data was published from the ANCHOR registry, a patient cohort with a high prevalence of challenging aortic anatomy and failure of sealing. 9 It was shown that increased infrarenal aortic diameter (>26 mm at the lowest renal artery) and a conical neck configuration were risk factors for type 1A endoleaks.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of complex abdominal aortic aneurysms by combining different types of endoprostheses

et al. 2016

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Outcome-based anatomic criteria for defining the hostile aortic neck

Cited by 93 publications

References 25 publications

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

Aortic Curvature Is a Predictor of Late Type Ia Endoleak and Migration After Endovascular Aneurysm Repair

Predeployed aortic extension cuff (kilt) in EVAR with hostile neck anatomy using Endurant II system: preliminary results

Endovascular treatment of complex abdominal aortic aneurysms by combining different types of endoprostheses

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